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I48 THE DENTAL MANPOWER SITUATION NOW AND IN THE FUTURE* KERMIT F. KNUDTZON, D.D.S. I have read and reread many times during the past month, the article on "Dental Manpower in North Carolina" written by Dean John C. Brauer, which was published in the August 1958 issue of the Journal of the North Carolina Dental Society. Written four years ago, it is uncanny in its predictions and reads as though it were written this past week. In the first sentence of th'is article, Dr. Brauer asks two basic and fundamental questions: (I) How many dentists should there be in the State of North Carolina, and (2) Who should decide this very important and basic question? In 1958 the national dental population ratio was 1:1900. The North Carolina ratio was 1:3900. These figures have re- mained relatively static over the years. Where has the population figure gone? Nationally it has risen 28 million from 1950-60. In the same period in the State of North Carolina it has increased one-half million. In the years 1950-60 the biggest rise has been in the larger cities. Charlotte rose from 134,000 t o 201,000; Winston-Salem from 87,000 to 111,000; Greensboro grew from 74,000 t o 120,000; and High Point from 40,000 t o 62,000. Some towns remained almost static in the 1950-60 decade and a few went in reverse. In answer to the question who knows what the ratio should be in North Carolina, the answer s t i l l remains the same as it was i n 1958, namely -- nobody knows. In answer to the question, "Should such a vital decision be made by the University with recommendations from the faculty of the School of Dentistry, by the North Carolina Dental Society, or by the State Legis- lature which represents the people of the State?" -- The answer i s again the same as Dean Brauer stated four years ago -- "The legislature in North Carolina, of course, will determine what *Part III of a panel discussion on "The Dental Manpower Problem -- Its Immediate and Future Impact on Dentistry" presented December 5, 1962 at the Eighth Annual Dental Seminar -- UNC School of Dentistry, Chapel Hill, North Carolina. Dr. Kermit F. Knudtzon is Professor and Head of Department of Practice Administration and Dental Science, Dental School, University of North Carolina, Chapel Hill, North Carolina.

THE DENTAL MANPOWER SITUATION NOW AND IN THE FUTURE

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THE DENTAL MANPOWER S I T U A T I O N NOW AND I N THE FUTURE*

KERMIT F . KNUDTZON, D.D.S.

I have read and re read many t i m e s d u r i n g t h e p a s t month, t h e a r t i c l e on "Den ta l Manpower i n N o r t h C a r o l i n a " w r i t t e n by Dean John C . B rauer , which was pub l i shed i n t h e August 1958 issue o f t h e Jou rna l o f t h e Nor th C a r o l i n a Den ta l Soc ie ty . W r i t t e n f o u r y e a r s ago, i t i s uncanny i n i t s p r e d i c t i o n s and reads as though i t were w r i t t e n t h i s p a s t week.

I n t h e f i r s t sentence o f t h ' i s a r t i c l e , D r . B rauer asks two b a s i c and fundamenta l q u e s t i o n s : ( I ) How many d e n t i s t s s h o u l d t h e r e be i n t h e S t a t e o f N o r t h C a r o l i n a , and ( 2 ) Who shou ld d e c i d e t h i s v e r y i m p o r t a n t and b a s i c q u e s t i o n ? I n 1958 t h e n a t i o n a l d e n t a l p o p u l a t i o n r a t i o was 1:1900. The N o r t h C a r o l i n a r a t i o was 1:3900. These f i g u r e s have r e - ma ined r e l a t i v e l y s t a t i c o v e r t h e y e a r s . Where has t h e p o p u l a t i o n f i g u r e gone? N a t i o n a l l y i t has r i s e n 28 m i l l i o n from 1950-60. I n t h e same p e r i o d i n t h e S t a t e o f N o r t h C a r o l i n a i t has i n c r e a s e d o n e - h a l f m i l l i o n . I n t h e y e a r s 1950-60 t h e b i g g e s t r i s e has been i n t h e l a r g e r c i t i e s . C h a r l o t t e r o s e f r o m 134,000 t o 201,000; Wins ton-Sa lem f rom 87,000 t o 111,000; Greensboro grew f rom 74,000 t o 120,000; and H i g h P o i n t from 40,000 t o 62,000. Some towns remained a lmos t s t a t i c i n t h e 1950-60 decade and a few went i n reverse.

I n answer t o the q u e s t i o n who knows what t h e r a t i o shou ld be i n Nor th Caro l i na , t h e answer s t i l l remains t h e same as i t was i n 1958, namely -- nobody knows.

I n answer t o t h e q u e s t i o n , "Shou ld such a v i t a l d e c i s i o n be made by t h e U n i v e r s i t y w i t h recommendat ions f rom t h e f a c u l t y o f t h e School o f D e n t i s t r y , by t h e N o r t h C a r o l i n a Denta l Soc ie ty , o r by t h e S t a t e Leg is - l a t u r e which rep resen ts t h e people o f t h e S ta te? " -- The answer i s aga in t h e same as Dean Brauer s t a t e d f o u r y e a r s ago --

"The l e g i s l a t u r e i n N o r t h C a r o l i n a , o f cou rse , w i l l d e t e r m i n e what

*Part I I I of a panel discussion on "The Dental Manpower Problem - - Its Immediate and Future Impact on Dentistry" presented December 5 , 1962 at the Eighth Annual Dental Seminar - - UNC School of Dentistry, Chapel Hill, North Carolina.

Dr. Kermit F. Knudtzon is Professor and Head of Department of Practice Administration and Dental Science, Dental School, University of North Carolina, Chapel Hill, North Carolina.

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a p p r o p r i a t i o n s a r e t o be d i r e c t e d t o d e n t a e d u c a t i o n , and, t h e r e b y , l i m i t t h e e x p a n s i o n and deve lopmen t o f t h e p r o f e s s i o n . However, t h e i n i t i a l l e a d e r s h i p i n t h i n k i n g , p lann ing , and a c t i o n i n my o p i n i o n shou ld come from b o t h t h e p r o f e s s i o n and t h e U n i v e r s i t y . The p r o f e s s i o n has a keen and ves ted i n t e r e s t i n t h e q u a l i t y and q u a n t i t y o f d e n t a l s e r v i c e t o be rendered t h e peop le o f t h e S ta te , and t h e U n i v e r s i t y must accep t t h e r e s p o n s i b i l i t y f o r t h e e d u c a t i o n and t r a i n i n g o f d e n t i s t s and o t h e r p r o f e s s i o n a l pe rsonne l c o n s i s t e n t w i t h t h e m i s s i o n , p l a n s , and commit- ments o f t h e t o t a l U n i v e r s i t y .

"There a r e many i n t e r d e p e n d e n t f a c t o r s and programs w i t h i n t h e U n i - v e r s i t y and t h e D i v i s i o n o f H e a l t h A f f a i r s , w h i c h must be c o n s i d e r e d b e f o r e D e n t i s t r y can be g i v e n t h e 'go-ahead' s i g n a l f o r any expans ion o r development program. For example, t h e need f o r expanded f a c i l i t i e s and an i n c r e a s e d annua l o p e r a t i n g b u d g e t f o r t h e B a s i c Sc iences must r e c e i v e equa l o r h i g h e r p r i o r i t y , s i n c e d e n t i s t r y cannot proceed w i t h o u t t h i s v i t a l i n s t r u c t i o n . The U n i v e r s i t y A d m i n i s t r a t i o n must assume t h e r e s p o n s i b i l i t y f o r d e t e r m i n i n g t h e r e l a t i v e need, and, a c c o r d i n g l y , t h e p r i o r i t y i n a l l e x p a n s i o n programs. The Dean and t h e f a c u l t y o f t h e Schoo l o f D e n t i s t r y and t h e p r o f e s s i o n o f d e n t i s t r y can make t h e i r recommendations t o t h e U n i v e r s i t y A d m i n i s t r a t i o n , and t h e l a t t e r c i t e d A d m i n i s t r a t i o n a f t e r an e v a l u a t i o n o f t h e U n i v e r s i t y ' s t o t a l needs p re - s e n t s i t s p l a n and budget t o t h e Board o f H i g h e r Educa t ion , t h e Budget Bureau, and t h e n t o t h e l e g i s l a t u r e .

"The a l l impor tan t q u e s t i o n a t t h e moment i s , does t h e N o r t h Caro l i n a D e n t a l S o c i e t y wh ich has a m a j o r i n t e r e s t i n t h e d e n t a l h e a l t h o f t h e peop le o f t h i s S t a t e , have a proposed p l a n o r a program f o r t h e p r e s e n t and f u t u r e d e n t a l manpower needs o f t he S ta te? Is t h e r e a n y t h i n g r e a l l y more i m p o r t a n t t o t h e d e n t i s t s o f t h e S t a t e ? I t i n v o l v e s a l l o f t h e peop le o f N o r t h C a r o l i n a , and i t i n v o l v e s t h e d a i l y l i v e s and economy o f every d e n t i s t and t h e i r f a m i l i e s . A d i s c u s s i o n o f how t o do a b e t t e r amalgam, i n l a y , o r den tu re , o r t h e b e s t t e c h n i q u e f o r t h e removal o f a too th , i s impor tan t a t meet ings o f ou r s o c i e t i e s . However, t h e q u e s t i o n o r p rob lem o f who i s go ing t o do t h e d e n t a l s e r v i c e and under what con- d i t i o n s t ranscends a l l o t h e r s u b j e c t s i n r e l a t i v e importance t o d e n t i s t s i nd i v i dua l l y and c o l 1 e c t i ve l y .

On what b a s i s -- p o p u l a t i o n , need, o r t h e demand f o r d e n t a l c a r e -- shou ld t h i s d e n t i s t - p o p u l a t i o n r a t i o be de te rm ined? The t r e n d and ex- t e n t o f v o l u n t a r y d e n t a l i nsu rance , t h e e s t a b l i s h m e n t o f u n i o n d e n t a l c l i n i c s , and Government h e a l t h p l a n s whe the r i t be t h e K e r r - M i l l s o r M e d i c a r e t i e d t o S o c i a l S e c u r i t y o r some o t h e r scheme w i l l d e t e r m i n e t o a g r e a t e x t e n t o u r f u t u r e demands -- b u t be assu red some o r a l l o f t h e s e p rog rams w i l l grow r a p i d l y i n t h e n e a r f u t u r e . L i k e w i s e , t h e d e n t a l demand o f t h o s e n o t i n v o l v e d i n t h e s e p rog rams w i l l a l s o i n - crease. Why? -- Because:

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1 . Peop le a r e e n j o y i n g a h i g h e r income p l u s more l e i s u r e t i m e than ever b e f o r e i n t h e h i s t o r y o f t h e U n i t e d Sta tes .

2. Peop le a r e becoming more aware o f t h e v a l u e o f t h e i r t e e t h bo th from a f u n c t i o n a l as w e l l as an e s t h e t i c p o i n t o f v iew, which means the d e n t a l demand w i 1 1 be g r e a t e r .

3. I nc reased d e n t a l e d u c a t i o n o f t h e l a y p u b l i c i n t h e d e s i r a b i l i t y of o b t a i n i n g and m a i n t a i n i n g b e t t e r o r a l h e a l t h .

4. The g r e a t r i s e i n p r i v a t e i n s u r a n c e , u n i o n h e a l t h b e n e f i t s and government med ica l programs which a r e l i k e w i s e making r a p i d in roads i n t o t h e d e n t a l f i e l d .

I n t h i s same a r t i c l e , Dr. B r a u e r s t a t e d t h a t D e n t a l Manpower Re- q u i r e m e n t s f o r N o r t h C a r o l i n a must be based on ( I ) Need v e r s u s demand f o r d e n t a l s e r v i c e s . ( 2 ) The r o l e o f p r e v e n t i v e d e n t i s t r y and t h e r e - s u l t s o f r e s e a r c h i n t h i s f i e l d . ( 3 ) The m i g r a t i o n o f d e n t i s t s wh ich i n c l u d e s t h e number o f d e n t i s t s who l e a v e and r e t i r e as w e l l as those a p p l y i n g and t a k i n g t h e S t a t e Boards , and ( 4 ) O f u t m o s t impor tance , t h e e f f e c t i v e use o f a u x i l i a r y pe rsonne l coup led w i t h t h e team concept o f d e n t a l p r a c t i c e . And, i f t h e number o f d e n t i s t s pe r p o p u l a t i o n were based p r i m a r i l y on t h e need, t h i s r a t i o would r e q u i r e 7 o r 8 t imes more d e n t i s t s than now i n p r a c t i c e i n N o r t h C a r o l i n a .

Income i s n a t u r a l l y a l a r g e f a c t o r i n t h e s e e k i n g o f d e n t a l ca re . For t h e U n i t e d S t a t e s t h e p e r c a p i t a income r o s e from $556 i n 1939 t o $2223 i n 1960. I n N o r t h C a r o l i n a p e r c a p i t a p e r s o n a l income was $316 i n 1939 as a g a i n s t $1574 i n 1960 o r an i n c r e a s e o f 400 p e r cen t . Two o t h e r v e r y i m p o r t a n t f a c t o r s must be c o n s i d e r e d i n N o r t h C a r o l i n a i n a d d i t i o n t o income. About o n e - f o u r t h o f t h e p o p u l a t i o n o f N o r t h Caro- l i n a i s Negro and t h r e e - f o u r t h s o f t h e p o p u l a t i o n i s r u r a l . The South- e r n E d u c a t i o n Board ( S R E B ) w h i c h i n v o l v e s 16 s o u t h e r n s t a t e s and i s c h a r g e d w i t h c o n t i n u a l l y a s s e s s i n g needs i n h i g h e r e d u c a t i o n i n t h e reg ion and f o r deve lop ing and recommending t o t h e s t a t e s and i n s t i t u t i o n s p l a n s and programs f o r m e e t i n g these needs recommended i n 1956, " t h a t t h e r e g i o n s e t a goa l o f d e n t a l c a r e f o r i t s c i t i z e n s which a t t h e ve ry l e a s t e q u a l s t h a t a v a i l a b l e f o r t h e n a t i o n as a whole -- and t h a t t h e r e g i o n must o b t a i n s u f f i c i e n t d e n t i s t s t o a c h i e v e by 1975 a r a t i o o f one d e n t i s t t o each 4 - m i l l i o n d o l l a r s o f income." I s t h i s t h e answer? Who knows, b u t i t s u r e l y i s more r e a l i s t i c t han t h e number o f u n f i l l e d c a v i t i e s i n t h e mouths o f t h e p o p u l a t i o n wh ich i s r e l a t i v e l y t h e same f o r r i c h and poor a1 i ke .

R e d u c t i o n i n c a r i e s t h r o u g h r e s e a r c h and p r e v e n t i v e measures i s a long, s low process . F l u o r i d a t i o n o f communal wa te r supp l i e s r e d u c i n g c a r i e s i n t h e now unborn and i n t h e c h i l d r e n o f America s t i l l meets w i t h v i o l e n t o p p o s i t i o n i n many areas . B e t t e r o r a l hyg iene i s a m a t t e r o f c o n s t a n t e d u c a t i o n and v i g i l a n c e -- b o t h o f wh ich a r e s a d l y l a c k i n g i n

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our p r e s e n t day youth . T h i s i s g r a p h i c a l l y i l l u s t r a t e d by t h e c o n t i n - u i n g i n c r e a s e i n each g e n e r a t i o n o f d e n t a l d i s e a s e . The deve lopmen t o f t h e j a w s o r p e r h a p s t h e l a c k o f deve lopmen t o f t h e j a w s p l u s t h e es the t . i c v a l u e p laced on Johnn ie ' s and Jenny 's t e e t h has seen a tremen- dous inc rease i n bo th the f i e l d s o f pedodont ics and o r t h o d o n t i c s . Ortho- dont ic : app l iances a r e becoming a s t a t u s symbol i n m i d d l e c l a s s as w e l l as upper c l a s s f a m i l i e s .

The U n i v e r s i t y i s c o g n i z a n t o f t h e f u t u r e need f o r i n c r e a s i n g t h e number o f d e n t i s t s and i n i t s l o n g range p l a n s has s e t an i n c r e a s e o f 25 d e n t a l s t u d e n t s p e r y e a r and an i nc rease o f f rom 15 t o 60 f o r d e n t a l h y g i e n i s t s . The number o f g raduate s t u d e n t s i n t h e seve ra l s p e c i a l t i e s w i l l l i k e w i s e be i n c r e a s e d p l u s t h e number and e x t e n t o f p o s t g r a d u a t e cou rses .

The s tudy and r e p o r t upon wh ich these f i g u r e s were based was fo rmu- l a t e d on t h e combined c o n c e p t s o f t h e Dean and f a c u l t y o f t h e Schoo l o f D e n t i s t r y . Dean B r a u e r t h e n c a r r i e d t h i s r e p o r t t o t h e House o f De legates and t h e General Assembly o f t h e N o r t h C a r o l i n a Den ta l S o c i e t y i n May 1958. The N o r t h C a r o l i n a D e n t a l S o c i e t y f o r m a l l y endorsed and adopted , a t t h a t t i m e , t h i s p a r t i c u l a r p rogram r e l a t i n g t o i n c r e a s e d numbers o f d e n t a l s t u d e n t s and d e n t a l hyg iene s t u d e n t s f o r t h e U n i v e r - s i t y , wh ich has been t h e b a s i s f o r a l l o f o u r d e f i n i t i v e p lann ing . The U n i v e r s i t y o f N o r t h C a r o l i n a has adopted t h i s l o n g range p l a n b u i l t on t h i s approved b a s i c p l a n by t h e N o r t h C a r o l i n a Den ta l Soc ie ty .

Thanks t o t h e D i v i s i o n o f Den ta l P u b l i c H e a l t h and Resources o f t h e U n i t e d S t a t e s Pub1 i c H e a l t h S e r v i c e , b e g i n n i n g n e x t June o u r t h r e e - month d e n t a l a s s i s t a n t e d u c a t i o n a l and t r a i n i n g program w i l l t a k e 20 g i r l s i n s t e a d o f 15 i n each c l a s s , and we hope t h i s can be r a i s e d t o 2 5 i n 1964.

However, t he inc rease i n d e n t a l s t u d e n t s and d e n t a l h y g i e n i s t s cannot be m e t u n t i l t h e new w ing o f t h e School o f D e n t i s t r y i s comple ted and ready f o r occupancy, and b e f o r e t h i s i s p o s s i b l e we must have expanded f a c i l i t i e s and o p e r a t i n g budget f o r t h e B a s i c Sc iences s i n c e d e n t i s t r y canno t proceed w i t h o u t t h i s v i t a l i n s t r u c t i o n . Because t h i s i s t e n o r more y e a r s away, what can we do now and i n t h e immediate f u t u r e ? The answer i s : ( I ) More e f f e c t i v e and e f f i c i e n t use o f o u r p r e s e n t a u x i l - i a r y pe rsonne l . ( 2 ) The team concep t o f d e n t a l p r a c t i c e -- u s i n g more and w e l l - t r a i n e d a u x i l i a r y he lp . ( 3 ) The expanded use o f such t r a i n e d a u x i l i a r y p e r s o n n e l , and ( 4 ) The e d u c a t i o n and t r a i n i n g o f s e l e c t e d women and men t o s t a f f o f f i c e s , s c h o o l s , and i n s t i t u t i o n s . L e t u s go i n t o augment ing these f o u r p o i n t s .

( I ) More e f f e c t i v e use -- E i g h t y - t w o p e r c e n t o f s e l f employed den- t i s t s employed a u x i l i a r y pe rsonne l i n 1958, e i t h e r f u l l o r p a r t t i m e . Den ta l a s s i s t a n t s were employed by 75.5 p e r cen t , s e c r e t a r i e s o r recep-

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t i o n i s t s by 16.1 p e r c e n t , h y g i e n i s t s by 14.0 pe r c e n t and d e n t a l l a b - o r a t o r y t e c h n i c i a n s by 5.4 p e r cen t . F u l l t i m e p o s i t i o n s as a s s i s t a n t s by p r i v a t e p r a c t i t i o n e r s was 65.6 p e r cen t . The s p e c i a l i s t h i r e s more a s s i s t a n t s than t h e genera l p r a c t i t i o n e r w h i l e t h e p e d o d o n t i s t employs the most a s s i s t a n t s and the p e r i o d o n t i s t t h e most h y g i e n i s t s . The t o t a l number o f d e n t i s t s i n 1961 i n c l u d i n g t h a t y e a r ' s g raduates was 106,796. 94,000 were a c t i v e i n t h e p r o f e s s i o n . O f these, a p p r o x i m a t e l y 91,000 p r a c t i c e d d e n t i s t r y , i . e . , worked a t t h e c h a i r , and some 3,000 were engaged i n teach ing , research, a d m i n i s t r a t i o n , e t c . Approx imate ly 3,300 d e n t a l s tuden ts a r e graduated each year.

The advan tage t o t h e g e n e r a l p r a c t i t i o n e r o f e m p l o y i n g d e n t a l as- s i s t a n t s can be summed up as f o l l o w s :

( a ) The mean number o f p a t i e n t s i nc reased from 742 f o r d e n t i s t s w i t h no employees t o 1,166 f o r d e n t i s t s w i t h one f u l l - t i m e employee, 1,530 f o r d e n t i s t s w i t h two f u l l t i m e employees, and 1,931 f o r d e n t i s t s w i t h t h r e e f u l l - t i m e employees. T h i s i s w i t h o u t r e g a r d t o t y p e o f employee o r number o f c h a i r s and u n i t s .

( b ) The mean g r o s s income o f a l l p r a c t i c i n g d e n t i s t s i n t h e U n i t e d S t a t e s f o r 1958, u s i n g one c h a i r and w i t h no h e l p o f any k i n d ( n o t even a r e c e p t i o n i s t ) was $14,065; f o r t h e d e n t i s t u s i n g two c h a i r s and one d e n t a l a s s i s t a n t , t h i s was $24,779; and f o r t h e d e n t i s t u s i n g two c h a i r s and two a s s i s t a n t s t h e g r o s s income ave rage was $36,451. Thus, i n a two-cha i r o f f i c e t h a t e x t r a a s s i s t a n t i s b r i n g i n g i n an a d d i t i o n a l g ross o f $12,000 pe r year t o t h a t o f f i c e .

Now, how e f f e c t i v e a r e these a s s i s t a n t s t h a t you employ? I t has been es t ima ted t h a t an u n t r a i n e d g i r l o r one t r a i n e d by a d e n t i s t who h imse l f has had no t r a i n i n g i n how t o p r o p e r l y t r a i n and u t i l i z e an a s s i s t a n t , i s o n l y 35 t o 50 p e r c e n t e f f e c t i v e . T h e r e f o r e , a w e l l - t r a i n e d g i r l , w o r k i n g f o r a d e n t i s t who i s l i k e w i s e t r a i n e d t o work e f f i c i e n t l y w i t h t h i s t y p e o f an employee c o u l d p o s s i b l y i n c r e a s e h i s p a t i e n t s e r v i c e s ( i n c l u d i n g income) t o t w i c e as much.

I n mid-1961, t h e r e were 1433 d e n t i s t s l i s t e d i n N o r t h C a r o l i n a , i n - c l u d i n g r e t i r e d d e n t i s t s , t eachers , research men, e t c . , e x c e p t i n g o n l y t h e Federa l Den ta l Se rv i ces . These f i g u r e s i n c l u d e t h e 1961 graduates . 106,796 l i v i n g d e n t i s t s were l i s t e d i n t h e 1962 A D A D i s t r i b u t i o n s o f D e n t i s t s i n t h e U n i t e d S t a t e s by S t a t e , Region, D i s t r i c t , and County. O f t h i s number o n l y 86,000 were i n p r i v a t e p r a c t i c e o r a p p r o x i m a t e l y 80.4 p e r c e n t . A c o m p a r a t i v e f i g u r e i n N o r t h C a r o l i n a wou ld i n d i c a t e t h a t o f 1433 l i v i n g d e n t i s t s , a p p r o x i m a t e l y 80 pe r c e n t or 1150 a r e i n a c t i v e p r i v a t e p r a c t i c e .

The o b j e c t i v e o f o u r p r e s e n t program o f t e a c h i n g t h e s e n i o r s t u d e n t t o work w i t h and u t i l i z e a c h a i r s i d e a s s i s t a n t i s t h a t each s t u d e n t , upon graduat ion , w i l l h i r e one f u l l - t i m e a s s i s t a n t i n h i s o f f i c e . There-

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f o r e , i n 1962, when t h e f i r s t such c l a s s was g r a d u a t e d a need o f 50 t r a i n e d c h a i r s i d e a s s i s t a n t s was e s t a b l i s h e d . T h i s w o u l d mean two s c h o o l s f o r d e n t a l a s s i s t a n t s w i t h a c l a s s o f 25 each. A p p r o x i m a t e l y 30 p e r c e n t o f each o f t h e s e c l a s s e s a r e l o s t t h e f i r s t y e a r c h i e f l y t h r o u g h m a r r i a g e and f o r o t h e r reasons . T h e r e f o r e i n 1963, f o r f i f t y g r a d u a t i n g d e n t i s t s i n N o r t h C a r o l i n a , we w i l l need 50 p l u s 15 o r 65 t r a i n e d c h a i r s i d e a s s i s t a n t s . I n 1964, we w i l l need 50 p l u s 30 ( i .e . , two y e a r s o f d r o p o u t s ) o r a t o t a l o f 80 c h a i r s i d e a s s i s t a n t s each y e a r t o supp ly ou r own graduates .

We have approx ima te l y 1150 d e n t i s t s now i n p r i v a t e p r a c t i c e i n N o r t h C a r o l i n a , and i f o n l y t e n p e r c e n t o f t h e s e r e q u e s t a f o r m a l l y t r a i n e d g i r l , we would need 115 a d d i t i o n a l g i r l s .

Thus: I n 1962, we needed 165 t r a i n e d a s s i s t a n t s o r seven schoo ls a t 25 p e r c l a s s . I n 1963, we wou ld need 220 (due t o t h e 30 p e r c e n t loss f a c t o r ) o r n i n e s c h o o l s p r o d u c i n g 25 p e r c l a s s . I n 1964, we w i l l need 293 ( w i t h t h e 1/3 l o s s f a c t o r ) o r 12 schoo ls w i t h 25 per c lass .

The above p rov ides o n l y one f o r m a l l y t r a i n e d a s s i s t a n t f o r o u r own grad- u a t e s each y e a r p l u s 10 p e r c e n t o f t h e p r a c t i c i n g d e n t i s t s i n N o r t h C a r o l i na .

Now, t h e u l t i m a t e o b j e c t i v e i s t o t e a c h eve ry d e n t i s t t o u t i l i z e n o t one b u t two f u l l y t r a i n e d and i n t e r c h a n g e a b l e d e n t a l c h a i r s i d e a s s i s t - an ts , I f we a r e e f f e c t i v e i n t h e t e a c h i n g o f t h i s p h i l o s o p h y o f p r a c - t i c e , t h i s wou ld d o u b l e t h e o r i g i n a l need o f 50 d e n t a l a s s i s t a n t s t o 100 a s s i s t a n t s and t h u s d o u b l e a l l o f t h e f i g u r e s w h i c h I have j u s t q u o t e d .

Thus, i n 1964 we would need 586 t r a i n e d d e n t a l a s s i s t a n t s each yea r o r t h e n e c e s s i t y o f 24 schoo ls w i t h a c a p a c i t y o f 25 per c lass .

The second answer i s t h e Team Concept o f D e n t i s t r y . Wherein a den- t i s t m i g h t employ one o r two a s s i s t a n t s , a r e c e p t i o n i s t - s e c r e t a r y , a h y g i e n i s t , and a d e n t a l l a b o r a t o r y t e c h n i c i a n i n h i s own e n v i r o n m e n t o r w i t h a g roup o f two o r t h r e e d e n t i s t s . There a r e n o t enough such p r a c t i c e s a t t h e p r e s e n t t i m e t o g i v e c o n c r e t e f a c t s and f i g u r e s , b u t t h i s t y p e o f a p r a c t i c e may w e l l be t h e p a t t e r n o f t h e f u t u r e , w h i c h would a l l o w f o r more d e n t a l s e r v i c e s t o t h e p u b l i c . T h i s c o u l d be one way o f c o u n t e r a c t i n g a t r e n d toward s o c i a l i zed d e n t i s t r y . Economica l l y , p h y s i c a l l y , and m e n t a l l y t h e d e n t a l p r a c t i t i o n e r o f t h e f u t u r e c a n n o t a f f o r d t o be a " l o n e wolf . '#

The t h i r d answer i s t h e Expanded Use o f Such A u x i l i a r y Personne l . The A D A House o f De lega tes a t t h e i r r e c e n t m e e t i n g i n Miami (1962) r e - d e f i n e d and m o d i f i e d t h e e x p e r i m e n t a l p o l i c y r e g a r d i n g t h e expanded t r a i n i n g programs f o r d e n t a l a s s i s t a n t s and d e n t a l h y g i e n i s t s wh ich was

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a d o p t e d a t t h e 1961 a n n u a l s e s s i o n . T h i s y e a r , t h e d e l e g a t e s amended t h e p o l i c y t o s t a t e t h a t " e x p e r i m e n t a t i o n must n o t i n c l u d e t h e f o l l o w i n g i tems:

--- D i agnos i s , t r e a t m e n t p 1 ann i n g and p r e s c r i p t i on. --- S u r g i c a l p r o c e d u r e s on h a r d and s o f t t i s s u e s . --- A l 1 r e s t o r a t i v e , p r o s t h e t i c , o r t h o d o n t i c and o t h e r p r o c e d u r e s

--- P r e s c r i p t i o n s f o r d r u g s , medicaments a n d / o r work a u t h o r i z a t i o n . The s e r v i c e s r e n d e r e d by t h e a u x i l i a r y p e r s o n n e l s h a l l remain under

w h i c h r e q u i r e t h e knowledge and s k i l l o f t h e d e n t i s t .

p e r s o n a l s u p e r v i s i o n o f t h e d e n t i s t . "

The d e l e g a t e s a l s o a p p r o v e d p r o c e d u r e s f o r r e v i e w o f r e s e a r c h f i n d - i n g s on such programs by t h e C o u n c i l on D e n t a l E d u c a t i o n . The C o u n c i l i s d i r e c t e d t o s u b m i t f i n a l r e p o r t s t o t h e A D A House o f D e l e g a t e s , t h e comments o f w h i c h a r e t o be t r a n s m i t t e d t o c o n s t i t u e n t s o c i e t i e s and S t a t e Boards o f D e n t a l Examiners f o r t h e i r a p p r o p r i a t e c o n s i d e r a t i o n .

C o n s i s t e n t w i t h t h e A D A House o f D e l e g a t e s a c t i o n a t t h e Miami meet- i n g , i t i s e s s e n t i a l t h a t a l l i n t e r e s t e d s c h o o l s g i v e s e r i o u s c o n s i d e r a - t i o n t o t h e c o n d u c t o f s u c h e x p e r i m e n t a l p rograms w i t h t h e f u l l k n o w l - edge, u n d e r s t a n d i n g , and a p p r o v a l o f t h e r e s p e c t i v e s t a t e d e n t a l s o c i e - t i e s .

The E d u c a t i o n and T r a i n i n g o f A u x i l i a r y P e r s o n n e l : T h i s i n c l u d e s t h e e d u c a t i o n and t r a i n i n g o f t h e s e a u x i l i a r i e s p l u s t h e a b i l i t y o f t h e . 'ental p r a c t i t i o n e r t o u t i l i z e t h i s t r a i n i n g t o t h e f u l l e s t .

As you know, f o r t h e p a s t s i x y e a r s , t h e U n i v e r s i t y o f N o r t h C a r o l i n a was one o f t h e p i o n e e r d e n t a l s c h o o l s s e l e c t e d t o p a r t i c i p a t e i n t h e e d u c a t i o n and t r a i n i n g o f d e n t a l a s s i s t a n t s and i n t e a c h i n g t h e d e n t a l s t u d e n t how t o e f f e c t i v e l y u t i l i z e such t r a i n e d a s s i s t a n t s a t t h e c h a i r - s i d e . These programs were sponsored by t h e p r e s e n t D i v i s i o n o f D e n t a l Pub1 i c H e a l t h and Resources, U.S. Pub1 i c H e a l t h S e r v i c e .

These s c h o o l p rograms v a r i e d e x t e n s i v e l y b o t h as t o t h e i r s e l e c t i o n and use o f a s s i s t a n t s as w e l l as t h e t i m e and amount o f t r a i n i n g g i v e n t h e d e n t a l s t u d e n t . However, a l l a g r e e d t h a t t h e p r i n c i p l e o f t e a c h i n g d e n t a l s t u d e n t s how t o work w i t h a w e l l - t r a i n e d and e x p e r i e n c e d d e n t a l a s s i s t a n t was an e s s e n t i a l need i n t h e c u r r i c u l u m o f d e n t a l s c h o o l s .

The House o f D e l e g a t e s o f t h e A D A passed a r e s o l u t i o n i n 1960 t h a t such t e a c h i n g o f d e n t a l s t u d e n t s i n t h e use o f d e n t a l a s s i s t a n t s s h o u l d be i n c l u d e d i n t h e c u r r i c u l u m o f a l l s c h o o l s o f d e n t i s t r y i n t h e U n i t e d S t a t e s . To d a t e a l l b u t one o r t w o s c h o o l s now have e s t a b l i s h e d such p r o g r a m s . Some h a v e been i n e x i s t e n c e f o r s e v e r a l y e a r s , o t h e r s a r e j u s t b e i n g i n i t i a t e d .

D r . Roger B a r t o n , C o - d i r e c t o r and G e n e r a l S u p e r v i s o r o f t h e S e n i o r D e n t a l A s s i s t a n t T r a i n i n g Program a t t h e U n i v e r s i t y o f N o r t h C a r o l i n a

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has o u t l i n e d o u r program as f o l l o w s :

( I ) To t r a i n s e n i o r d e n t a l s t u d e n t s how t o work e f f i c i e n t l y and e f - f e c t i v e l y w i t h a w e l l - t r a i n e d c h a i r s i d e a s s i s t a n t o r a s s i s t a n t s .

( 2 ) To t e a c h t h e s e n i o r d e n t a l s t u d e n t how t o c o o r d i n a t e t i m e and p roduc t i on so t h a t he may be o f s e r v i c e t o an increased number o f people.

A d d i t i o n a l T r a i n i r g : Our p r e s e n t program a t t h e U n i v e r s i t y o f N o r t h C a r o l i n a i n t h e S p e c i a l S e n i o r O p e r a t i v e Program c o n s i s t s o f one week each q u a r t e r w o r k i n g i n t h e a d u l t c l i n i c w i t h a f u l l - t i m e c h a i r s i d e a s s i s t a n t p l u s t h e use o f a r o v i n g a s s i s t a n t when needed. A f t e r one y e a r , we a r e o f t h e o p i n i o n t h a t a t h r e e weeks e x p e r i e n c e i s n o t e - nough. We hope t o broaden ou r p e r s p e c t i v e and t o improve o u r l e v e l o f t r a i n i n g t o t h e v a r i o u s age l e v e l s and c l i n i c a l d i s c i p l i n e s .

C o n s i d e r a t i o n i s a l s o b e i n g g i v e n t o t r a i n the d e n t a l s t u d e n t i n t h e team concept , by w o r k i n g w i t h a d e n t a l h y g i e n i s t , and a d e n t a l l a b o r a - t o r y t e c h n i c i a n i n a d d i t i o n t o a d e n t a l c h a i r s i d e a s s i s t a n t i n a t o t a l team e n v i ronment and e f f o r t .

What a r e t h e o t h e r programs and p o t e n t i a l s i n N o r t h C a r o l i n a f o r t h e t r a i n i n g o f a u x i l i a r y pe rsonne l?

The f i r s t c l a s s i n d e n t a l a s s i s t i n g conducted a t t h e B u r l i n g t o n I n - d u s t r i a l E d u c a t i o n a l C e n t e r o f B u r l i n g t o n , N . C . , was g r a d u a t e d t h i s p a s t summer. T h i s i s a o n e - y e a r c o u r s e ( 1 2 months ) and c o n s i s t s o f t h e educa t ion and t r a i n i n g o f young women a t a v o c a t i o n a l school l e v e l . Lec tu res , l a b o r a t o r y , s e c r e t a r i a l , and d e n t a l c h a i r s i d e a s s i s t i n g b o t h a t t h e schoo l and i n t h e o f f i c e s o f s e l e c t e d p r i v a t e p r a c t i t i o n e r s was t h e F i r s t y e a r p a t t e r n . Ten g i r l s ( r e s i d e n t s i n o r nea r B u r l i n g t o n ) s u c c e s s f u l l y comple ted t h i s course . D r . Raymond MacKenzie, a UNC grad- u a t e i s d i r e c t o r o f t h e s c h o o l ; and t h e d e n t a l a s s i s t a n t s u p e r v i s o r , M r s . M i l d r e d Bowen Lynch i s a g r a d u a t e o f t h e UNC D e n t a l A s s i s t a n t Course .

Other such schoo ls i n i n d u s t r i a l t r a i n i n g c e n t e r s a r e i n the p l a n n i n g s tage. These p o t e n t i a l s a r e i n Goldsboro, C h a r l o t t e , Durham, and Gas- t o n i a , N o r t h Caro l i na.

D e n t a l L a b o r a t o r y T e c h n i c i a n s Course: I n September o f t h i s y e a r , t h e f i r s t c l a s s was e n r o l l e d i n t h e Denta l L a b o r a t o r y Technology Course a t t h e Durham I n d u s t r i a l E d u c a t i o n a l C e n t e r , Durham, N.C. T h i s i s a two-year r e s i d e n t program o f t h e h i g h e s t c a l i b e r . The c u r r i c u l u m i n - c l u d e s mathematics, p h y s i c s , c h e m i s t r y , anatomy, p h y s i o l o g y as w e l l as m e t a l l u r g y and d e n t a l m a t e r i a l s , p l u s t h e numerous c o u r s e s i n d e n t a l l a b o r a t o r y techn iques . Severa l y e a r s o f p r e p a r a t i o n p l u s hundreds o f man h o u r s o f con fe rences and p l a n n i n g by t h e e n t i r e s t a f f o f t h e I n - d u s t r i a l Educa t ion Center a t Durham, t h e O f f i c e r s o f t h e N o r t h Caro l i n a D e n t a l S o c i e t y , D r . C o l i n Osborne, J r . , Cha i rman o f t h e P r o s t h e t i c

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D e n t a l S e r v i c e C o m m i t t e e o f t h e N o r t h C a r o l i n a D e n t a l S o c i e t y , p l u s t h e members o f h i s c o m m i t t e e : members o f t h e f a c u l t y o f t h e UNC Schoo l o f D e n t i s t r y , e s p e c i a l l y Dean B r a u e r , D r . Roger B a r t o n , D r . Dav id Dobson; and D r . Norman Ross. D r . R o s s was p r e s i d e n t o f t h e N o r t h C a r o l i n a D e n t a l S o c i e t y a t t h e t i m e t h i s p rogram was i n i t i a t e d . These men p l u s many o t h e r s were r e s p o n s i b l e f o r b r i n g i n g t h i s e x c e l l e n t and much needed schoo l i n t o b e i n g i n Durham.

Clr. F o r r e s t D. Wirt, f o r m e r l y o f E l k h a r t , I n d i a n a , i s t h e s u p e r v i s o r o f t h e p r o g r a m and d e n t a l t e c h n i c a l i n s t r u c t o r . He has had v a s t e x - p e r i e n c e i n t h e t r a i n i n g o f d e n t a l l a b o r a t o r y t e c h n i c i a n s as t h e f o r m e r Head o f t h e D e n t a l L a b o r a t o r y D e p a r t m e n t , E l k h a r t U n i v e r s i t y , S c h o o l o f M e d i c a l and D e n t a l Techn iques . Drs. Dobson and B a r t o n a r e p r e s e n t l y s e r v i n g o n t h e C o m m i t t e e o f C o n s u l t a n t s f o r t h i s p a r t i c u l a r p r o g r a m .

Wh i l e t h i s f i r s t c l a s s i s composed o f e l e v e n members (9 N o r t h Caro- l i n i a n s and 2 o u t - o f - s t a t e ) t h e maximum p o t e n t i a l i s t w e n t y . The gen- e r a l i s t c o u r s e c o n s i s t s o f t w o academic y e a r s . S p e c i a l i s t c o u r s e s i n Crown and B r i d g e , Ceramics , e t c . a r e i n t h e p l a n n i n g s t a g e . I t i s a l s o p l a n n e d t h a t r e f r e s h e r c o u r s e s w i l l be g i v e n i n t h e f u t u r e t o employed l a b o r a t o r y t e c h n i c i a n s i n v a r i o u s abases o f l a b o r a t o r y techno logy .

E s t a b l i s h i n g s c h o o l s and t h e e q u i p p i n g o f t h e s e s c h o o l s i s r e l a t i v e l y s i m p l e . Money can buy b r i c k and m o r t a r and bunsen b u r n e r s , b u t i t can- n o t buy t h e t e a c h e r s needed t o s u p e r v i s e and c a r r y o u t t h e s e programs.

Our m a i n p r o b l e m i s g o i n g t o be: V'here a r e we g o i n g t o g e t t h e t e a c h e r s t o t e a c h i n a l l o f t h e s e s c h o o l s ? A D . D . S . d e g r e e o f f e r s a s s u r a n c e o f s c h o l a r l y a t t a i n m e n t b u t none as t o p e d o g o g i c a l s k i l l and m o s t d e n t a l t e a c h e r s have had l i t t l e , i f any, t r a i n i n g i n t h e Art o f Teach ing . L i k e w i s e c o m p e t e n t and e x p e r i e n c e d d e n t a l a s s i s t a n t s become a l m o s t s p a s t i c a t t h e v e r y t h o u g h t o f t e a c h i n g .

Good t e a c h e r s i n any f i e l d a r e s c a r c e and i n d i r e demand. Some o f t h e t e a c h i n g o f d e n t a l a s s i s t a n t s m u s t be done by d e n t i s t s ; b u t t h e m a j o r i t y o f t h e t e a c h i n g w i l l h a v e t o be done by d e n t a l a s s i s t a n t s . P l a c i n g f i r s t t h i n g s f i r s t , we m u s t t r a i n a l a r g e number o f d e n t a l a s s i s t a n t s t o be t e a c h e r s . T h i s i s a c r u c i a l p o i n t i n o u r e n t i r e d e n t a l a u x i l i a r y i n s t r u c t i o n a l p r o g r a m . I n a d d i t i o n t o a v a i l a b i l i t y , t h e s e women m u s t be m a t u r e enough t o m e r i t t h e r e s p e c t o f t h e t r a i n e e s , and must have a d e d i c a t e d d e s i r e t o teach.

We need t o d e v e l o p p r o g r a m s i n s e v e r a l c e n t e r s f o r t r a i n i n g s e l e c t d e n t a l a s s i s t a n t s t o be t e a c h e r s , i . e . , t e a c h e r t r a i n i n g p r o g r a m s . T h i s , n o d o u b t , i s one o f o u r g r e a t e s t p r o b l e m s w h i c h must be r e s o l v e d i m m e d i a t e l y i f we a r e t o a p p r o a c h s u c c e s s f u l l y t h e t e a c h i n g o f l a r g e numbers o f a s s i s t a n t s .

What a b o u t t h e d e n t a l h y g i e n i s t s ? The l o n g r a n g e p l a n n i n g a t t h e

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U N C S c h o o l o f D e n t i s t r y when t h e p r o j e c t e d e x p a n s i o n o f t h e d e n t a l s c h o o l i s a r e a l i t y , i s t o l i k e w i s e e x p a n d t h e e n r o l l m e n t o f d e n t a l h y g i e n i s t s f r o m a c l a s s o f 15 p e r y e a r t o 60 p e r y e a r . P e r h a p s t h e n we can b e g i n t o s u p p l y some o f you d e n t i s t s w i t h a h y g i e n i s t even though Dan C u p i d d o e s g i v e us l o t s o f c o m p e t i t i o n . I n t h i s r e g a r d , I m i g h t add t h a t t h e D e n t a l H y g i e n i s t s A s s o c i a t i o n h a s gone on r e c o r d a s n o t b e i n g o p p o s e d t o m a l e h y g i e n i s t s . I am c o n v i n c e d t h a t i n t h e y e a r s ahead we w i l l see an i n f l u x o f m a l e s i n t h e r o l e s o f b o t h h y g i e n i s t and a s s i s t a n t . However , A m e r i c a n D e n t i s t r y i s n o t r e a d y f o r i t now.

P r i o r t o 1885, d e n t a l a s s i s t a n t s w e r e m a l e s and i n t h a t y e a r , D r . Edmund C . K e l l s o f New O r l e a n s s h o c k e d t h e d e n t a l w o r l d o f t h a t day by e m p l o y i n g a f e m a l e a s s i s t a n t , and a p p a r e n t l y t h e i d e a s p r e a d l i k e w i l d f i r e . They say t h a t e v e r y t h i n g goes i n c y c l e s and t h a t t h e pendulum s w i n g s b o t h ways -- We s h a l l see.

A n o t h e r avenue o f t r a i n i n g d e n t a l a s s i s t a n t s i s t h e UNC c o r r e s p o n d - ence c o u r s e w h i c h t o d a t e has a t o t a l e n r o l l m e n t o f 967 s i n c e i t began i n 1953. A l l b u t t h r e e o f t h e 50 s t a t e s a r e r e p r e s e n t e d i n c l u d i n g A l a s k a and Hawai i p l u s W a s h i n g t o n , D . C . , Jamaica , Canada, P u e r t o R i c o and France. You may n o t know t h a t t h e d e n t a l c o r r e s p o n d e n c e c o u r s e i s t h e l a r g e s t i n e n r o l l m e n t and s c o p e o f t h e e n t i r e E x t e n s i o n D i v i s i o n o f o u r U n i v e r s i t y . Any h i g h s c h o o l g r a d u a t e o r e q u i v a l e n t , who may o r may n o t be w o r k i n g i n a d e n t a l o f f i c e i s e l i g i b l e . The c o u r s e con- s i s t s o f 27 l e s s o n a s s i g n m e n t s and a f i n a l s u p e r v i s e d e x a m i n a t i o n . I t may be c o m p l e t e d by t h e s t u d e n t i n seven weeks (min imum) o r 13 months (maximum). The c o s t i s o n l y $60. The o f f i c i a l manual i s t h e B r a u e r - R i c h a r d s o n T e x t , "The D e n t a l A s s i s t a n t , " a u t h o r e d by a l a r g e number o f o u r f a c u l t y . The s u c c e s s f u l c o m p l e t i o n o f t h i s c o u r s e w h i c h has been a p p r o v e d by t h e A m e r i c a n D e n t a l A s s i s t a n t s A s s o c i a t i o n , ( a n d i s t h e o n l y c o r r e s p o n d e n c e c o u r s e a p p r o v e d by t h e m ) m e e t s t h e r e q u i r e m e n t s f o r t h e C e r t i f i c a t i o n E x a m i n a t i o n o f t h e A D A A .

The 1 0 4 - h o u r E x t e n s i o n S t u d y C o u r s e , w i t h s i m i l a r p r e p a r a t i o n f o r c e r t i f i c a t i o n i s g i v e n u n d e r d i r e c t i o n o f t h e A D A A i n v a r i o u s c i t i e s i n N o r t h C a r o l i n a . T h i s , o f c o u r s e , i s open o n l y t o g i r l s now employed as d e n t a l a s s i s t a n t s .

Where does t h e now p r a c t i c i n g d e n t i s t f i t i n t o t h i s p i c t u r e -- one who was g r a d u a t e d b e f o r e t h e s e s t u d e n t d e n t i s t - a s s i s t a n t p rograms came i n t o b e i n g ? T h i s i s a r e a l c o n c e r n a n d o n e w h i c h n e e d s e v e r y o n e ' s a t t e n t i o n . Those p r a c t i t i o n e r s who w e r e g r a d u a t e d b e f o r e 1962 ( w i t h t h e e x c e p t i o n o f t h o s e s c h o o l s h a v i n g p i l o t - s t u d y programs) s h o u l d have some p r o v i s i o n f o r t h o s e who d e s i r e t o have a d d i t i o n a l t r a i n i n g i n t h e e f f e c t i v e use o f c h a i r s i d e a s s i s t a n t s t h r o u g h r e f r e s h e r o r p o s t g r a d u a t e c o u r s e s . These c a n be c o n d u c t e d by d e n t a l s c h o o l s , by d e n t a l s t u d y g r o u p s , b y d e n t a l s o c i e t i e s t h r o u g h t h e u s e o f c l i n i c s and t r a i n i n g f i l m s , by c i t y o r c o u n t y h e a l t h d e p a r t m e n t s o r by p r i v a t e d e n t a l p r a c -

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t i t i o n e r s who a r e l e a d e r s i n t h e use o f m u l t i p l e a u x i l i a r y pe rsonne l . Many d e n t a l s c h o o l s a r e now g i v i n g such r e f r e s h e r c o u r s e s and o t h e r s p 1 an t o .

C e c i l B1 i s s , H a r r y K lenda , John Anderson, and R o b e r t S t i n a f f a r e among t h e fo remost p roponents o f p r a c t i c e a d m i n i s t r a t i o n i n t h e coun t ry . Each o f t h e s e men has been most e m p h a t i c a b o u t t h e f u n c t i o n and t h e advantages t o d e n t i s t r y i n t h e e f f e c t i v e use o f a u x i l i a r y d e n t a l p e r - sonnel .

I t has a l s o been t h e p o l i c y whenever p o s s i b l e t o b r i n g i n and t o d e m o n s t r a t e t h e need and v a l u e o f a u x i l i a r y p e r s o n n e l i n t h e r e c e n t pos tg radua te s tudy cou rse g i v e n a t t h e U n i v e r s i t y . T h i s ph i l osophy has been p a r t i c u l a r l y n o t e w o r t h y i n t h e Courses i n D e n t i s t r y f o r C h i l d r e n g i v e n by t h e D e p a r t m e n t o f P e d o d o n t i c s . T h i s b e l i e f has been sub- s c r i b e d t o n o t o n l y by t h e members o f t h e pedodon t i c f a c u l t y conduc t ing t h e s e c o u r s e s , b u t by t h e g u e s t l e c t u r e r s who have appeared on t h e v a r i o u s programs, such as Roy Wolfe, F r a n c i s Summers, John Woehler and o t h e r n a t i o n a l l y known c l i n i c i a n s .

I n c o n c l u s i o n -- t h e d e n t i s t s o f N o r t h C a r o l i n a a r e assuming respon- s i b i l i t y i n a ve ry d e f i n i t e manner i n f i n d i n g ways o f s o l v i n g the d e n t a l manpower s i t u a t i o n as r e f l e c t e d i n t h e a c t i o n o f you r House o f Delegates i n 1958. T h i s i s shown i n t h e f o r m u l a t i o n o f d e f i n i t e l o n g range p l a n s and more r e c e n t l y i n a s s i s t i n g i n the a c t i v a t i o n o f t he Dental Labora tory Techn ic ians Program a t t h e I n d u s t r i a l Educat ion Center i n Curham. L i k e - wise, i n h e l p i n g t o e s t a b l i s h the Denta l A s s i s t a n t Program i n B u r l i n g t o n and i n t h e p r e s e n t p l a n n i n g o f s i m i l a r s c h o o l s f o r d e n t a l a s s i s t a n t s i n o t h e r c i t i e s o f t h e S ta te .

However, we have much t o l e a r n and t o g a i n i n t h i s S t a t e and i n ou r d e n t a l e d u c a t i o n a l programs by f i n d i n g ways and means o f b e t t e r u t i l i z a - t i o n o f a u x i l i a r y personne l .

I am c e r t a i n t h a t many a d d i t i o n a l f i n d i n g s w i l l be e s t a b l i s h e d from t h e r e s u l t s o f o u r p r e s e n t p rograms h e r e a t t h e s c h o o l i n t h e use o f a u x i l i a r y pe rsonne l and t h a t t h e d e n t i s t s o f t h i s S t a t e w i l l g i v e con- s i d e r a t i o n and approva l f o r t h e cont inuance and expansion o f exper imental programs f o r the e f f e c t i v e use o f such a u x i l i a r y personnel .

The d e n t a l p r o f e s s i o n o f t h i s S t a t e has a l r e a d y demonst ra ted t h e i r c o n c e r n i n t h i s a r e a , and I am c o n f i d e n t t h a t t h e y w i l l c o n t i n u e t o exp ress t h i s same v i t a l i n t e r e s t i n t h e t o t a l manpower p rob lem o f the f u t u r e .

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BIBLIOGRAPHY

I . American Den ta l A s s o c i a t i o n , Bureau o f Economic Research and S t a t i s - t i c s . D i s t r i b u t i o n o f d e n t i s t s i n t h e Un i ted S t a t e s by s t a t e , reg ion , d i s t r i c t , and county. 1962.

t i c s . The 1959 Survey o f Den ta l P r a c t i c e .

t i c s . Fac ts about s t a t e s f o r t h e d e n t i s t seek ing a l o c a t i o n . 1962.

2. American Denta l A s s o c i a t i o n , Bureau o f Economic Research and S t a t i s -

3. American Den ta l A s s o c i a t i o n , Bureau o f Economic Research and S t a t i s -

4. American Denta l Assoc ia t i on , News le t te r , Vol . 15, No. 20, November 15,

5. B r a u e r , John C . , D e n t a l Manpower i n N o r t h C a r o l i n a . J . N . C . D . S . 4 l : 3 , August 1958.

6. Brauer , John C . , Wasted Economy and Wasted Manpower -- A P l e a f o r More and B e t t e r Tra ined Ass i s tan ts . J.A.D.A. 60:368, March, 1960.

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7. Frank1 in , Ben., Poor R i c h a r d ' s Almanac.

8. Knudtzon, K e r m i t F . , Need f o r Teach ing E f f e c t i v e U t i l i z a t i o n o f Ser- v i c e s o f a Denta l A s s i s t a n t , J.A.D.A., 64: 109, January 1962.

9. Knudtzon, K e r m i t F. Problems R e l a t e d t o Inc reased T r a i n i n g o f Aux- i l i a r y Personnel . Proceedings o f t h e Workshop on t h e Fu tu re Requ i re - ments o f Dental Manpower and t h e T r a i n i n g and U t i l i z a t i o n o f A u x i l i a - r y Personne l . U n i v e r s i t y o f M ich igan , W . K. K e l l o g g Founda t ion I n - s t i t u t e , January 15-19, 1962.

10. Wor ld Almanac and Book o f F a c t s . New York Wor ld Te leg ram and t h e Sun. 1953, 1961.